Citation Nr: 9813140
Decision Date: 04/28/98 Archive Date: 05/08/98
DOCKET NO. 95-00 132 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in San Juan,
Puerto Rico
THE ISSUE
Entitlement to service connection for pruritus ani.
REPRESENTATION
Appellant represented by: Puerto Rico Public Advocate
for Veterans Affairs
ATTORNEY FOR THE BOARD
S. D. Regan, Counsel
INTRODUCTION
The veteran had active service from October 1989 to October
1993. This matter came before the Board of Veterans' Appeals
(hereinafter "the Board") on appeal from a March 1994 rating
decision of the San Juan, Puerto Rico Regional Office
(hereinafter “the RO”) which, in pertinent part, denied
service connection for pruritus ani. The veteran has been
represented throughout this appeal by the Puerto Rico Public
Advocate for Veterans Affairs.
The Board notes that a June 1996 rating decision, in
pertinent part, denied the veteran’s claim for entitlement
service connection for skin disorder, other than pruritus
ani, claimed as due to an undiagnosed illness. In a
September 1996 statement on appeal, the veteran advanced
contentions which the Board has construed as a notice of
disagreement to such issue. The Board observes, however,
that this issue has not been procedurally developed for
appellate purposes and is not properly before the Board at
this time. Therefore, such issue is referred to the RO for
appropriate action.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran asserts on appeal that he is entitled to service
connection for pruritus ani. The veteran contends,
essentially, that he incurred such disorder during his period
of service. He reports that he was treated for the claimed
disorder during service and that he presently suffers from
such disorder. The veteran avers that he has continued to
receive treatment for pruritus ani since his discharge from
service.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991 & Supp. 1997), has reviewed and considered
all of the evidence and material of record in the veteran's
claims file(s). Based on its review of the relevant evidence
in this matter, and for the following reasons and bases, it
is the decision of the Board that the record supports the
allowance of service connection for pruritus ani.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the veteran’s appeal has been obtained by the
RO.
2. The veteran’s pruritus ani had origins during active
service.
CONCLUSION OF LAW
Pruritus ani was incurred in active service. 38 U.S.C.A.
§§ 1110, 1131, 5107 (West 1991 & Supp. 1997); 38 C.F.R.
§ 3.303 (1997).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Initially, it is necessary to determine if the veteran has
submitted a well-grounded claim within the meaning of 38
U.S.C.A. § 5107(a) (West 1991 & Supp. 1997), and if so,
whether the VA has properly assisted him in the development
of his claim. A “well-grounded” claim is one which is not
implausible. A review of the record indicates that the
veteran’s claim is plausible and that all relevant facts have
been properly developed. Accordingly, a remand, in order to
allow for further development of the record is not
appropriate.
Service connection may be granted for a disability arising
from disease or injury incurred in or aggravated by active
service. 38 U.S.C.A. § 1110, 1131 (West 1991 & Supp. 1997).
The disease entity for which service connection is sought
must be "chronic" as opposed to merely "acute and transitory"
in nature. For the showing of chronic disease in service,
there is required a combination of manifestations sufficient
to identify the disease entity and sufficient observation to
establish chronicity at the time as distinguished from merely
isolated findings or a diagnosis including the word
"chronic". Continuity of symptomatology is required where
the condition noted during service is not, in fact, shown to
be chronic or where the diagnosis of chronicity may be
legitimately questioned. Where the fact of chronicity in
service is not adequately supported, then a showing of
continuity after discharge is required to support the claim.
38 C.F.R. § 3.303(b) (1996). Service connection may be
granted for any disease diagnosed after discharge, when all
the evidence, including that pertinent to service,
establishes that the disease was incurred in service. 38
C.F.R. § 3.303(d) (1996).
The United States Court of Veterans Appeals (hereinafter
“the Court”) has held that in order for a claim for service
connection to be well-grounded, there must be (1) competent
evidence of a current disability; (2) proof as to incurrence
or aggravation of a disease or injury in service; and (3)
competent evidence as to a nexus between the inservice injury
or disease and the current disability. See Caluza v. Brown,
7 Vet.App. 498 (1995).
The veteran’s service medical records indicate that he was
treated for pruritus ani on multiple occasions during his
period of service. A June 1992 treatment entry noted that
the veteran was seen with anal pruritus since August 1991.
The examiner reported that the veteran’s anal area was very
macerated. The assessment included pruritus ani. A July
1992 consultation sheet noted that the veteran complained of
pruritus ani with little relief from conservative treatment.
The examiner, at that time, noted a small erythematous
perianal area with no maceration. The assessment was
pruritus ani. A May 1993 treatment entry also related an
assessment of pruritus ani with fissures. An August 1993
examination report indicated diagnosed disorders including
pruritus ani.
The veteran underwent a VA general medical examination in
January 1994. He complained of rectal and anal bleeding at
times with severe anal pruritus and anal fissures. The
examiner noted anal pruritus with fissure in the perianal
region. The mucosa was scratched and red. The diagnoses
included chronic anal pruritus and anal fissures with
occasional bleeding. A January 1994 VA rectal examination
report noted that the veteran’s pruritus would occur on and
off, but more frequently in the past few months. The rectal
exam showed tender anal mucosa, but no obvious deformities.
The examiner diagnosed pruritus ani.
In his December 1994 substantive appeal, the veteran reported
that his pruritus ani started while he was in service and had
continued since service separation. He reported that he had
suffered from such disorder over a period of four years. The
veteran stated that such disorder required continuous
treatment and medication.
The veteran underwent an additional VA general medical
examination in March 1995. He complained of scattered lumps
over his body under the skin. The diagnoses included
lipomatosis. An April 1995 VA dermatological report
indicated that the veteran reported a history of a rash on
his face, chest and forehead as well as scaliness of the
scalp. He also complained of a history of “vences” very
pruritic in the “groins”. The examiner reported that the
veteran had a mild erythema macule in the perianal area.
There were also non-tender nodules in the perianal area, the
back and the buttocks. The diagnoses included pruritus ani
chronic, recurrent disorder of psychological origin,
seborrhea dermatitis and multiple lipoma.
The Board has made a careful longitudinal review of the
record. It is observed that the veteran’s service medical
records indicate that the was treated for pruritus ani on
multiple occasions during his period of service. The August
1993 examination report indicated diagnosed disorders
including pruritus ani. Additionally, the Board notes that a
January 1994 VA general medical examination report related
diagnoses including chronic anal pruritus and anal fissures
with occasional bleeding. A January 1994 VA rectal
examination indicated a diagnosis of pruritus ani. The Board
further observes that an April 1995 VA dermatological
examination report noted that the veteran had a mild erythema
macule in the perianal area. The diagnoses included pruritus
ani chronic, recurrent disorder of psychological origin. The
Board observes that the medical evidence of record clearly
indicates that the veteran was treated for the claimed
disorder during his period of service and that he has been
diagnosed with pruritus ani as recently as April 1995.
Therefore, the Board is of the view that the evidence is at
least in equipoise as to this matter and that to conclude
otherwise than that such disorder was incurred during the
veteran’s period of service would not withstand Court
scrutiny. Accordingly, with resolution of reasonable doubt
in favor of the veteran, the Board concludes that service
connection for pruritus ani is warranted.
ORDER
Service connection for pruritus ani is granted.
JEFF MARTIN
Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1997), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.
- 2 -